Reflex Testing & Procedure Chart
Chemistry
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code for Reflex Billing |
|---|---|---|---|
Free Phenytoin (FRPTN) | Phenytoin > 2.5 | Free Phenytoin | 80186 |
Free Valproic Acid (FRVALP) | Valproic Acid > 12.0 | Free Valproic Acid | 80164 |
TSH Reflexive (TSHR) | TSH < 0.45 or > 4.50 | Free T4 | 84439 |
Qualitative HCG with reflex to Quantitative HCG (HCGQR) | Positive qualitative result | Quantitative HCG | 84702 |
HIV-1 / HIV-2 Antibody Screen (HIV12, HIVNS, HIVNE) | Positive | BioRad Geenius HIV ½ If Neg (first time) HIV viral load will be performed | 86703 87536 |
Hepatitis B Surface Antigen (HBSAG) | Positive | Hepatitis B Confirmation (if not previously done) | 87301 |
Hepatitis C Antibody (HCVAB) | Positive | Hepatitis C Viral Load (HCV) | 87522 |
Serum Protein Electrophoresis (SPEP) | Abnormal findings | IG Quantitation (QUANT) Immunofixation (IMFIX)/Freelites | 82784 x3 83883 x2 |
Hemoglobin Electrophoresis (HGBEP) | Abnormal Hemoglobins | Hemoglobin Acid Electrophoresis (ACIDHB) | 83020 |
Hemoglobin Electrophoresis (HGBEP) | Abnormal findings of A2 or F | Quantitation for A2 or F (send out) | 83021 |
Calcium reflex to PTH, Intact | Calcium <8.5 or > 10.5 | PTH, Intact | 82310 83970 |
Note: Free Drug test request includes free and total drug levels | |||
Microbiology/Molecular
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Throat Screen for Strep (TS) | Negative | Culture | 87081 |
Bacterial Culture | Positive | Identification | 87077 87070 83789 87185 87156 87181 87184 |
Fungal Culture | Positive | Identification Susceptibility | 87106 83789 87186 |
Cryptococcal AG CRYPG | Cryptococcal Ag Positive | Funcal Culture, CSF FUNCSF | 87102 |
AFB Culture | Positive | Identification | 87118 83789 87149 |
C diff PCR | Positive | C diff Toxin Antigen | 87493 87324 |
Genomics
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Colorectal CA Molecular Analysis | KRAS no mutation detected | BRAF | 81210 |
Toxicology
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Drugs of Abuse Screening | Any positive results | Confirmation | 80102 |
Drugs of Abuse Confirmation | Any positive result not identified by screen | Confirmation | 80102 |
Buprenorphine/Norbuprenorphine | Positive for Fentanyl/Norfentanyl | Quantitative Fentanyl results will be reported to the patient’s chart. | 80348 80354 |
Immunology
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Serum Syphilis Screen (SYPTAB) | Positive | Rapid Plasma Reagin Titer (RPRT) Quantitation | 86593 |
SYPTAB and RPRT | Discordant results and no previous history | Treponemal Pallidum Antibody Assay (TPPA) | 86780 |
Celiac IgA Panel | <7 mg/dL | Celiac IgG Panel | 83516 (X2) |
Cytology
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Thin Prep Pap | ACS or AGS Diagnosis | Human Papillomavirus (HPVGEN) | 87621 |
Blood Bank
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Type and Hold | Positive Antibody Screen | Antibody Identification (ABID) | 86870 |
Type and Hold | Positive Antibody Screen | Antigen Information (AGIO) | 86903 (per antigen per unit crossmatched) |
Type and Hold (on patient scheduled for surgery) | Positive Antibody Screen | Crossmatch two units of blood | 86920 |
Type and Screen | Positive Antibody Screen | Antibody Identification (ABID) | 86870 |
Antibody Screen (ordered separately or as part of battery) | Positive Antibody Screen | Antibody Identification (ABID) | 86870 |
Antibody Identification | Inconclusive Result | Direct Antiglobulin Test | 86880 |
New Antibody Identification | All Patients | Direct Antiglobulin Test, Drug-Associated Antibody Identification Phenotype and/or RBC antigen genotype | 86880 86978
|
Direct Antiglobulin Test (polyspecific) | Positive | Direct Antiglobulin Test (monospecific) | 86880 |
Direct Antiglobulin Test | Positive | Antibody Screen | 86850 |
Platelet Evaluation | Positive | Platelet Crossmatch | 86023 |
Cord Blood Workup | If the mother has a non-ABO IgG antibody or is Group O, and the child is Group A or B, or no current mother’s sample is available | Direct Antiglobulin Test | 86880 |
Cord Blood Workup | Positive Direct Antiglobulin Test | Antibody Screen if no current mother’s sample | 86850 |
Cord Blood Workup | Positive Direct Antiglobulin Test, and the mother has an IgG antibody | Eluate | 86860 86870 |
Fetal Bleed Screen | Positive | Fetal Hemoglobin Stain | 85460 |
Fetal Bleed Screen | Infant with weak D | Fetal Hemoglobin Stain | 85460 |
Transfused Red Cells | Patient with Antibody | Antigen type units | 86903 (per antigen per unit crossmatched) |
Type and Hold | Diagnosis of sickle cell disease | Phenotype the patient’s red cells | 86905 86906 |
Transfused Red Cells | Diagnosis of sickle cell disease | Phenotype the patient’s red cells | 86905 |
Transfused Red Cells | Diagnosis of sickle cell disease | Antigen typing Rh and K compatible units | 86903 |
Transfused Red Cells | Diagnosis of Thalassemia or a patient with warm autoantibody that has not been recently transfused | Phenotype patient’s red cells | 86905 86906 |
Transfused Red Cells | Chronically transfused patient | Phenotype the patient's red cells | 86905 86906 |
Transfused Red Cells | Previously transfused patient with auto-antibody | Auto- or differential absorptions | 86978 |
Transfusion Reaction Workup | Positive Direct Coombs in which a new antibody is discovered | Elution and antigen typing of all transfused units | 86860 86870 86903 |
HLA or cross-matched platelets | None | Irradiate | 86945 |
Transfuse cellular products | All red cell and platelet products | Irradiate | 86945 |
Reference Lab
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Borrelia burgdorferi antibody (Lyme’s Disease) | Positive or equivocal | Western Blot | 86617 (x2) |
Paraneoplastic Autoantibody Screen | Dependent upon initial results | Varies | Variable depending upon Ab found |
Mycoplasma pnuemoniae Antibodies, IgG and IgM, Serum | If IgM is positive or equivocal | IgM by indirect immunofluorescence assay (IFA) | 86738 |
Cytogenetics
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Amniotic Fluid Study (CTGAFS) | Suspicious or abnormal standard chromosome finding | Fluorescent in situ hybridization | 88271 and one of the following: 88272 88273 88274 88275 |
Chorionic Villus Sample (CTGCVS) | Suspicious or abnormal standard chromosome finding | Fluorescent in situ hybridization | 88271 and one of the following: 88272 88273 88274 88275 |
Lymphocyte Study (CTGLS) | Suspicious or abnormal standard chromosome finding | Fluorescent in situ hybridization | 88271 and one of the following: 88272 88273 88274 88275 |
Bone Marrow / Unstim. Blood (CTGBMS) | Suspicious or abnormal standard chromosome finding | Fluorescent in situ hybridization | 88271 and one of the following: 88272 88273 88274 88275 |
Fibroblast Study (CTGFBS) | Suspicious or abnormal standard chromosome finding | Fluorescent in situ hybridization | 88271 and one of the following: 88272 88273 88274 88275 |
Tumor Study (CTGSTS) | Suspicious or abnormal standard chromosome finding | Fluorescent in situ hybridization | 88271 and one of the following: 88272 88273 88274 88275 |
Chromosome Microarray (CMA) | Abnormal screen | Fluorescent in situ hybridization | 88271 and one of the following: 88272 88273 88274 88275 |
Urinalysis
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Urinalysis with reflex culture (UACUL) | positive leukocyte esterase, or positive nitrite, or >10 white blood cells/HPF, or any bacteria present | Urine Culture | 87086 |
Hematology
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
CBC with Reflex to Ferritin | 1st or 3rd trimester and HGB <11.0 g/dl 2nd trimester and HGB <10.5 g/dl | Ferritin | 85027 |
Heparin-Induced Platelet Antibody | Positive | Serotonin Release Assay (SRA) | 86022 |
Surgical Pathology
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Biopsy or Consult Request | Glioglastoma (WHO grade IV) | MGMT (06-Methylguanine-DNA-Methtransferase) Gene Methylation Assay | 83891 |
IHC Reflex Testing
Initial Requested Test | Reflex Criterion | Reflex Test or Procedure | CPT Code |
|---|---|---|---|
Breast (biopsy, lump, mastectomy) | DCIS | ER | 88360 |
Breast (biopsy, lump, mastectomy or metastasis) | Invasive carcinoma (ductal or lobular) | ER PR HER2 ISH | 88360 88360 88377 |
Non-skin head/neck biopsy or resection (Order if base of tongue, oropharynx, tonsil, neck lymph node; ask attending if other site) | Squamous cell carcinoma | p16 | 88342 |
Stomach, esophagus, or metastasis | Gastric or esophageal Adenocarcinoma | HER2 4B5 IHC | 88342 |
Colon: biopsy; do on resection if not done on bx. | Colon: any carcinoma | PMS2 HER2 4B5 IHC | 88342 |
Uterus: hysterectomy; do on previous biopsy if no tumor in hysterectomy | Uterus: any carcinoma | PMS2 | 88342 |
Uterus: hysterectomy | Serous carcinoma | HER2 4B5 IHC | 88342 |
Ovary | Ovary: endometrioid or clear cell types only | PMS2 | 88342 |
Renal pelvis/ureter resection | Upper Tract urothelial carcinoma | PMS2 | 88342 |
Skin or metastasis | Melanomas over 1.0 mm or metastasis to any site | PD-L1 (SP263) | 88342 |
Lung or metastasis | Pulmonary Squamous Cell Carcinoma OR Small Cell Carcinoma | PD-L1 (SP142) | 88342 |
Lung or metastasis | Pulmonary Adenocarcinoma | RET and ROS1 FISH | 88365 x 2 |